Payments to people not eligible now count as errors
What the document says“payments (other than payments described in subclause (I)) for items and services furnished to an individual who is not eligible for medical assistance under the State plan (or a waiver of such plan) with respect to such items and services, or payments where insufficient information is available to confirm eligibility.”
The section adds a new subclause (III) to section 1903(u)(1)(D)(i) of the Social Security Act bringing within erroneous excess payments those for items and services given to someone not eligible for them, and those where there is not enough information to confirm eligibility. Matching words are added to subclause (II). The changes apply beginning with fiscal year 2030.
What the document actually says“payments (other than payments described in subclause (I)) for items and services furnished to an individual who is not eligible for medical assistance under the State plan (or a waiver of such plan) with respect to such items and services, or payments where insufficient information is available to confirm eligibility.”
Some payments now count as errors. One is a payment for care given to someone who does not qualify. Another is one where that cannot be checked.
Both add to the state's error figure. A higher figure can cost federal money. The changes start with fiscal year 2030.
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